侧后方经关节突入路治疗胸腰段椎间盘突出及椎体后缘软骨结节等引起的椎管狭窄症

目的:对胸腰段椎间盘突出、椎体后缘软骨结节等疾病利用侧后方经关节突入路进行减压治疗,探讨该疗法的优缺点。方法:本组14例患者,男9例,女5例;年龄33~60岁,平均46.4岁。病史1周~6年。椎间盘突出或伴有钙化11例,椎体后缘软骨结节3例。病变部位在T10,111例,T11,123例,T12L16例,L1,24例。有腰部外伤及扭伤史6例,其中有2例为急性车祸外伤。均行侧后方经关节突椎间盘、钙化椎间盘或者椎体后缘软骨结节切除,植骨及内固定术。结果:本组1例出现术后神经损害加重,经过治疗后逐渐恢复。14例均获随访,时间为1.0~4.5年,平均2.8年。参考Otani疗效评定标准,本组优5例,良5例,可3例,差1例,优良率为71.4%。13例术后症状获改善,胸腹部束带感消失5例,括约肌功能恢复正常2例。结论:侧后方经关节突入路对脊柱的损伤较小,本术式视野清晰,多数手术医师对此入路非常熟悉,并且可以切除椎弓根及部分肥厚关节突或椎板及黄韧带以充分减压。

Posterior laterally transpedicular approach in treating disc herniation and lumbar posterior marginal intraosseous cartilaginous node

Objective: To discuss the value of posterior laterally transpedicular approach in the surgical treatment of the disc herniation and lumbar posterior marginal intraosseous cartilaginous node(LPMN).Methods: Among 14 patients,9 were male and 5 were female,ranging in age from 33 to 60 years,with an average of 46.4 years.The disease course was from one week to 6 years.The spinal canel stenosis was at the level of T10,11 in 1 patient,at the T11,12 level in 3 patients,at the T12L1 level in 6 patients,and at the L1,2 level in 4 patients.Six patients suffered from previous lumbar sprain and 2 suffered from acute traffic accidents.Eleven patients had intervertebral disk herniation or were accompanied with calcification,and 3 patients had cartilaginous node at the posterior of vertebrae.All the patients underwent calcified discectomy and posterior osteophyte removal,bone-grafting and instrumentation through the posterior laterally transpedicular approach.Results: All the patients were followed(ranged,1.0 to 4.5 years),with an average of 2.8 years.According to Otani evaluation criterion,5 patients gained an excellent result,5 good,3 fair and 1 bad,the excellent and good rate was 71.4%.After operation,1 patient had nervous injuries increased,and gradually recovered after treatment.The clinical symptoms relieved in 13 patients,lumbar zonesthesia disappeared in 5 patients,and sphincter function recovered to normal in 2 patients.Conclusion: The disc herniation and LPMN of the thoracolumbar junction could be treated with the posterior laterally transpedicular approach.In case of the centrally calcified disc or osteophytes,the facet at one side could be resected to make more operative fields.This approach has less traumatic and is familiar to most of the spine surgeons.